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. 2021 May 26;8:677977. doi: 10.3389/fcvm.2021.677977

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Copyright © 2021 Kazik, Kandail, LaDisa and Lincoln.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Hemodynamic Influences on Valvular Performance in BAV. A normal TAV features a centrally-aligned velocity jet through the valve orifice at physiologic magnitudes (1.1 to 2.3 m/s, minimum velocity range). Symmetrical vortices form in the cusp sinus of TAV which lead to synchronous closure of valve cusps. BAV R/L and BAV R/NC configurations have skewed velocity jets with magnitudes of 2.0 to 5.0 m/s (maximum velocity range) through the valve orifice due to asymmetric cusp geometry and impaired mobility of the fused cusp (28, 29, 32, 51–53). This is directed toward the right anterior wall of the AAo in BAV R/L and toward the right posterior AAo wall in BAV R/NC. Asymmetrical vortex formation leads to a smaller, faster vortex in the non-fused cusp sinus and a larger, slower vortex in the fused cusp sinus that extends further into the AAo (36–38, 40, 41, 47). AAo, ascending aorta; BAV, bicuspid aortic valve; R, right; L, left; NC, non-coronary.